Set up electronic claim/RA file sharing
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires that all health care providers and payers must use the X12 5010 version to exchange EDI business data.
Electronic data interchange (EDI) setup
We accept EDI files through a direct connection via Secure File Transfer Protocol (SFTP) and through clearinghouses.
Priority Health doesn't publish companion guides, as we strictly adhere to HIPAA standards. Refer to Washington Publishing for X12 guides.
Submit the following forms to the Priority Health EDI team at email@example.com.
- To receive the 835 payment/remittance advice electronically: Electronic Remittance Advice (835) Registration form.
- To receive service receipts electronically: Service receipt registration form.
Claim service receipts
Service receipts summarize the number of claims submitted to Priority Health, including upfront rejections.
- They are sent directly to your office by email or fax as selected by your office.
- The report lists any claims rejected up front for invalid or missing data elements.
Transaction types available for EDI
- 270, Eligibility requests, batch and real time
- 271, Eligibility responses, batch and real time
- 276, Claim status requests, batch and real time
- 277, Claim status responses, batch and real time
- 277CA, Claim acknowledgment
- 278, Authorizations
- 834, Group enrollment
- 835, Payment/Remittance advice
- 837P, 837I and 837D, Claims
- 999, Functional acknowledgements
Real-time transaction exceptions
Eligibility and claim status transactions are both available 24/7, with these exceptions:
- Regularly scheduled maintenance periods, which occur on the second weekend of each month.
- Non-routine downtime periods, which are published a week in advance.
- Unscheduled downtime periods, which are communicated within an hour directly to clearinghouses and/or trading partners who utilize real time services.
Direct questions about electronic data interchange setup to the Priority Health EDI team via email at firstname.lastname@example.org.
If you have additional questions about member status, provider portal, Filemart, or payments email provider services at ProviderServices@priorityhealth.com. All provider credentialing, EFT enrollment, W-9 forms and banking question email Provider Enrollement Lifecycle at PH-PELC@priorityhealth.com.
Also in this Provider Manual:
- Billing & payment
- Procedures & services
- Reviews & appeals
- Medical policies
- Cigna Strategic Alliance
- Requirements & responsibilities
- Clinical resources
- News & education
- Fraud, waste & abuse policy
- Request an online account
- Join our networks
- Check patient eligibility
- Plans & benefits
- Set up electronic claims
- Set up electronic funds transfer (EFT)
- Check claim status